A last act of love for a loved one

January 13, 2014

Death is typically not a topic that most people want to think about, much less talk about, but it's an important one all the same, and something that all of us will eventually have to face. It can come fast or slow, with assistance or without, accidentally or on purpose. There's not exactly a way to prepare for it, either, but there are directives people can use to help ease the transition.

"We prepare for everything else, so why not prepare for this (end of life decisions)? It's a last act of love for a person," said Cliff Nelson, chaplain director for Pastoral Services at Trinity Health. End-of-life decisions should be as comfortable for people to talk about as the weather, he added. Talking about such decisions doesn't make the prospect of death easier, Nelson said, but it's something people need to talk about.

Nelson said it's important to have a plan in place for when you can't speak for yourself, known as an advanced directive, so that everyone in your family is on the same page.

Article Photos

Jill Hambek/MDNCliff Nelson, chaplain director for Pastoral Services at Trinity Health, left, explains a section in the advanced directive form to Mary Muhlbradt in the Trinity Skywalk on Thursday afternoon. Nelson said talking about end-of-life decisions isn’t easy, but they are something people need to talk about.

"The important part is the talking that goes on," he said.

These kind of decisions should be something that all people consider when they're of sound mind, because the person has to fully understand what he or she is doing. If the family knows about the person's wishes with no question, however, an advanced directive is not as pertinent, Nelson said.

"It's just a good thing to look at and complete, just to take it out of the taboo-type area," he added. "It opens the door to look at other issues and a good starting point."

An advanced directive goes into effect only when a person's condition is terminal and the patient can't speak for himself, Nelson said. So if a person was undergoing surgery and went into cardiac arrest, the doctor will resuscitate him or her, he continued, because the surgery isn't terminal, just corrective. If the person has a stroke while in surgery or immediately following and the damages are irreversible, however, then the doctor would not resuscitate.

"An advanced directive is only looked at when death is imminent," Nelson said.

Many people do not have their end-of-life wishes documented, and it comes back to not wanting to talk about the issue, Nelson said. Only 40 to 50 people will request an advanced directive form each month, he said, and only half a dozen of those forms are returned. People need to understand that just because they fill out the form doesn't mean they'll die tomorrow, Nelson said.

He said that advanced directives are fairly new, and include power of attorney and a living will. Also included are directives about artificial nutrition and hydration.

Advanced directives make a difference for a sense of peace, though, Nelson said, "and I always encourage people to ask questions about this document."

To make your end-of-life wishes official, Nelson said he talks with the patient or interested person. They fill out the form, return it to him and he'll get the form to where it needs to go. The form also has to be signed in the presence of two witnesses or notarized, he said. The two witnesses cannot be a spouse or member of the family, however, nor anyone designated as the potential patient's agent, a person entitled to inherit any part of their estate or anyone who has any claim against the estate.

There are a lot of dynamics that go into helping people make end-of-life decisions, Nelson said, but the key part as hospital chaplain is to be present.

"Let them voice their concerns and I'll let them know what it all means," he said.

Mainly, though, Nelson is there for people to help support them in the process.

"I'm there to get you through this," he said. "I try to be a place of comfort and a non-anxious presence. There's never a time where it's easy as chaplains, but we want to be a presence. When people need someone, we're there to help them through it."

"This isn't a morbid thing, but a chance to be prepared," Nelson said about advanced directives and making end-of-life decisions. "The form helps because the family knows what the person's wishes are."